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SAN JOAQUIN COUNTY w,w ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: US Page-A— of �;2—, Facility Address: TT City: (1�_,, i Inspects n Date: SVD D C �' O7� �J 25D /2 FA M PR M Program Element: joo Oma S 3 Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 11,320 gallons in tanks*and containers`*. Complete one box for each tank or each cumulative container product type. Tank (2820) ❑ Containers (2821) #of Containers: TA#: g 5204 1 Total Capacity: �' 07 pO gallons Product Type: I l) �p }?J? (per tank or cumulative for wn&soars by product type) Install Date: I Tank (2820) ❑ Containers (2821) #of Containers: TA#: / \ 2 Total Capacity: :A 000 gallons Product Type: LA,4 jOt) 71`�� ( 26[d-l4"1\lt ) (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 42 3 Total Capacity: -7, -7 0 0 gallons Product Type: (per tank or cumulative for containers by product type) X/ A Install Date: ❑ Tank (2820) containers (2821) #of Containers: TA#: QSj��q 4 Total Capacity: '�`'-0 gallons Product Type: {2eG� d u-2 C606W V P\l (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) containers (2821) #of Containers: (TA#: 5 Total Capacity: cD tJ gallons Product Type: f�Gt fly (per tank orcumulative forcontainers by producttype) Install Date: Total Capacity this Page: gallons Total Capacity for Site: pS 1 0 :5 gallons Comments: EHD Inspector: Reviewed 1(�, Date: Id I Entered Date: By Indial: V 1" _ I By Initial: /- a i `Abov rou torage tank means a tank that has the capacity to store 55 gallons or more of petroleum.u `*Contac means a storage device designed to be moved when full. EHD 29-01 AST SURVEY FORM 09/12/08